The debate over whether to expand Medicaid could be a key issue in the competitive Senate races in Louisiana and Mississippi, political experts say.

WASHINGTON – The debate over whether to expand Medicaid could be a key issue in the competitive Senate races in Louisiana and Mississippi, political experts say.

“This is an issue that would seem to have a lot of potential because both states have large populations of uninsured people,” said Albert Samuels, a political scientist at Southern University in Louisiana.

Democratic and Republican candidates have been at odds over whether states should expand Medicaid, an option under the 2010 Affordable Care Act. Medicaid is the federal-state health insurance program for the poor.

The issue is particularly thorny in the Deep South, which has become more conservative and where two of the nation’s most competitive Senate races are underway.

Republican candidates have sided with GOP Govs. Bobby Jindal of Louisiana and Phil Bryant of Mississippi, who decline to expand Medicaid.

Democrats argue that expansion would help thousands of uninsured and working poor in the two states.

Twenty-six states and the District of Columbia have decided to expand Medicaid eligibility, according to the Kaiser Family Foundation, a health care research organization. Mississippi and Louisiana are among the 21 opting not to expand. Three have yet to decide.

“The gap in coverage affects a lot of people,” said Ron Pollack, executive director of Families USA, a national health care advocacy group. “So this means an overwhelming majority of these folks will continue to be uninsured and will not be able to get the health care they need because they can’t afford it.”

In Mississippi, 333,000 residents would benefit from the expansion; 422,000 would be helped in Louisiana, Pollack said.

In states that expand eligibility, the federal government will pay 100 percent of those costs for the first three years, then 90 percent. States must come up with the remaining 10 percent.

Jindal said expanding Medicaid would cost Louisiana taxpayers more than $1 billion over 10 years.

Sen. Mary Landrieu, D-La., who is running for re-election, voted for the Affordable Care Act and has also pushed for changes in the law. She and Jindal have sparred over health care policies, including whether to expand Medicaid.

Landrieu urged supporters on Thursday to sign a petition calling for Jindal to close the “Jindal Gap” and accept expansion.

“It’s a very good law,” she told reporters last year. “It holds a lot of promise. ... But is this law perfect? No. Can it be improved? Yes. And we will continue this year and in the years to come to improve and strengthen it.”

Rep. Bill Cassidy, one of Landrieu’s Republican opponents in the Nov. 4 election, opposes expanding Medicaid and has criticized her for supporting the health care law.

Cassidy, a physician, has voted to repeal or modify the law and reintroduced a bill last year that would restructure Medicaid’s payment system.

Retired Col. Rob Maness, a Republican also running against Landrieu, said the law should be repealed.

David Bositis, a political analyst who specializes in Southern politics, said the issue could work for Landrieu, particularly if she faces a runoff in December.

A survey Bositis authored last year for the Joint Center for Political and Economic Studies, a nonpartisan think tank that focuses on issues impacting African-Americans, found most people in Southern states favor expanding Medicaid.

Overall the Affordable Care Act remains unpopular, the report found.

Pollack said Landrieu’s support could help her campaign. “It’s good policy and good politics to bring it up and to try to push the state to accept the federal funding,” he said.

But Samuels said Democrats haven’t taken advantage of the timing, which also comes as Jindal pushes a controversial plan to privatize the state’s hospital system.

“Democrats have been unwilling or unable to exploit the potential power of this issue,” he said. “There are potentials here to try to convince people this is not just a problem that affects poor people.”

“They have already called him all kinds of names anyway,” said Samuels. “I don’t think he cares, but if he called for the expansion of Medicaid they (would say) he has really sold out — so that’s not going to happen.”

Cochran has called the Affordable Care Act “deeply flawed” and voted to repeal or modify it. He has also agreed with state GOP officials who say Mississippi can’t afford the expense of Medicaid expansion.

“Senator Cochran’s views on the Affordable Care Act have not changed, but (he) recognizes that it’s the state’s decision to make,” said Chris Gallegos, a Cochran spokesman.

Pollack said Cochran’s position could backfire.

“By standing aside and failing to promote the states asking for these federal resources to extend coverage, he can be blamed for the result,” he said.

Travis Childers, a former Democratic congressman challenging Cochran, called it an “absolute shame” that Mississippi Republican lawmakers oppose the expansion.

“If I were a United States senator today you could rest assured I would be on the phone or in their office visiting with Gov. Bryant, Lt. Gov. Tate Reeves and all of these Republicans legislators who have excellent health care — thanks to the state of Mississippi,” said Childers. “And I would be saying, ‘If you don’t have compassion on these 300,000 people, if you can’t have compassion on the men and women, then for God’s sake have compassion on the children who don’t have access to health care.’ ”

Jeffrey Sadow, a political scientist at Louisiana State University at Shreveport, said he doesn’t expect Medicaid expansion to be a critical issue.

Still, he said, he could see a Democratic candidate “trying to wedge it in somewhere as a tactic to win votes of potential recipients under expansion.”